Publication: Invitations, Incentives, and Conditions: A Randomized Evaluation of Demand-Side Interventions for Health Screenings
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2022-03
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2022-03
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This randomized controlled trial investigates the impact of four demand-side interventions on health screening for diabetes and hypertension among Armenian adults. The interventions are 1) personalized invitations from a physician, 2) personalized invitations with information about peer screening behavior, 3) personalized invitations with a labeled but unconditional financial incentive, and 4) personal invitations with a conditional financial incentive. Compared with the control group, interventions 1 to 3 led to a significant increase in the screening rate of about 15 percentage points for diabetes and hypertension. The highest impact was measured for intervention 4 leading to a 31.2 percentage point increase in both screenings.
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Publication Invitations, Incentives, and Conditions(World Bank, Washington, DC, 2020-07)The study is a randomized controlled trial that investigates the impact of four demand-side interventions on health screening for diabetes and hypertension among Armenian adults ages 35-68 who had not been tested in the last 12 months. The interventions are personal invitations from a physician (intervention group 1), personal invitations with information about peer screening behavior (intervention group 2), a labeled but unconditional cash transfer in the form of a pharmacy voucher (intervention group 3), and a conditional cash transfer in the form of a pharmacy voucher (intervention group 4). Compared with the control group in which only 3.5 percent of participants went for both screenings during the study period, interventions 1 to 3 led to a significant increase in the screening rate of about 15 percentage points among participants. The highest intervention impact was measured among recipients in intervention group 4, whose uptake of screening on both tests increased by 31.2 percentage points. The levels of cost-effectiveness of intervention groups 1, 2, and 4 are similar while for intervention group 3 it is about twice more expensive per additional person screened.Publication Invitations and Incentives(Springer Nature, 2020-12)Non-communicable diseases account for a growing proportion of deaths in Armenia, which require early detection to achieve disease control and prevent complications. To increase rates of screening, demand-side interventions of personalized invitations, descriptive social norms, labeled cash transfers, and conditional cash transfers were tested in a field experiment. Our complementary qualitative study explores factors leading to the decision to attend screening and following through with that decision, and experiences with different intervention components. An individual’s decision to screen depends on 1) the perceived need for screening based on how they value their own health and perceive hypertension and diabetes as a harmful but manageable condition, and 2) the perceived utility of a facility-based screening, and whether screening will provide useful information on disease status or care management and is socially acceptable. Following through with the decision to screen depends on their knowledge of and ability to attend screenings, as well as any external motivators such as an invitation or financial incentive. Personalized invitations from physicians can prompt individuals to reconsider their need for screening and can, along with financial incentives, motivate individuals to follow through with the decision to screen. The effect of descriptive social norms in invitations should be further studied. Efforts to increase preventive screenings as an entry point into primary care in Armenia may benefit from implementation of tailored messages and financial incentives.Publication Effective Responses to Non-communicable Diseases : Embracing Action Beyond the Health Sector(World Bank, Washington, DC, 2011-09)Effective responses to non-communicable disease: Embracing action beyond the health sector focuses on solutions, indicating opportunities for the prevention and control of non-communicable diseases (NCDs) and the kinds of actions that will achieve it. NCDs exact a heavy toll on individuals and society. They cause disease, disability, and death, and reduce productivity which is vital for development. They also impose hefty costs on health services, particularly since NCDs frequently lead to ongoing disability and need for long-term care. Prevention that results in healthy aging and the reduction of morbidity is far more cost-effective and financially sustainable than treatment alone. 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(2) What determines and drives this burden, and what are the commonalities with communicable diseases? (3) What is the rationale for public intervention? (4) How could resource-constrained governments approach NCD prevention and treatment and road safety in a comprehensive, effective and efficient way? The data show that action against NCDs and RTIs in Sub-Saharan Africa is needed, together with continued efforts to address communicable diseases and maternal and child health as well as to reach the Millennium Development Goals (MDGs). The report suggests that NCDs and RTIs should not be tackled separately as a vertical program, nor should they displace communicable diseases as priorities. Instead, given resource constraints, and some shared determinants, characteristics, and interventions, there is scope for an integrated approach focusing on functions (prevention, treatment, and care) rather than on disease categories. Examples are cited of potential opportunities to integrate and add NCD prevention and treatment into existing services and programs. Proven, cost-effective, prevention interventions are clearly needed, many of which (such as tobacco and alcohol taxes, road safety measures, and fuel-efficient ventilated cook-stoves) require action beyond the health sector. These can deliver broader development benefits in addition to their benefits for health. Selective, evidence-based actions to reduce NCDs and RTIs will address the changing disease burden in Africa and achieve a more sustainable improvement in health outcomes, more efficient use of resources, and better equity across patients and populations.
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